Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ilham Derhan Putra

Individual provider Anatomic Pathology & Clinical Pathology Physician · NPI 1770110389

Ilham Derhan Putra is a Pathology in New York, New York. Qualified in 2013, 13 years ago. Practices as a sole proprietor. Licensed in New York.

Years since qualifying
13
Licensed in
NY
In the registry since
2020
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Practice location Address checks out

525 E 68th St
New York, NY 10065-4870
Phone: (813) 789-3508
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Anatomic Pathology & Clinical Pathology Physician (primary) Taxonomy 207ZP0102X · Licence 337333-01 (NY)

Record details

NPI number1770110389
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 24, 2020
Last updated in NPPESJune 25, 2026
Certification dateJune 25, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPATHOLOGY
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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