{"npi":"1508801713","type":"NPI-2","status":"active","name":{"display":"200 Chestnut St LLC","other":[],"organization_name":"200 CHESTNUT ST LLC","authorised_official":"Sanjay Shah"},"specialty":{"primary_taxonomy":"3336C0003X","primary_taxonomy_description":"Community/Retail Pharmacy","slug":"community-retail-pharmacy","schema_org_specialty":null,"all":[{"code":"333600000X","description":"Pharmacy","primary":false,"state":null,"license":null},{"code":"3336C0003X","description":"Community/Retail Pharmacy","primary":true,"state":"NJ","license":"28RS00660900"}]},"addresses":[{"purpose":"LOCATION","street_1":"200 CHESTNUT ST","city":"ROSELLE PARK","state":"NJ","postal_code":"072042263","country_code":"US","phone":"9082451396","fax":"9082451616"},{"purpose":"MAILING","street_1":"200 CHESTNUT ST","city":"ROSELLE PARK","state":"NJ","postal_code":"072042263","country_code":"US","phone":"9082451396","fax":"9082451616"}],"license":{"state":"NJ","number":"28RS00660900"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"0102831","state":"NJ","issuer":null},{"type_code":"01","label":"Other","value":"2054615","state":null,"issuer":"PK"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20100930062025","type_code":"30-A5","type_desc":"DME SUPPLIER - PHARMACY","state":"NJ","pac_id":"2860694668"},{"enrlmt_id":"O20110110000128","type_code":"12-73","type_desc":"PART B SUPPLIER - MASS IMMUNIZATION (ROSTER BILLER ONLY)","state":"NJ","pac_id":"2860694668"}]},"enumeration_date":"2006-06-19","last_updated":"2017-02-16","_meta":{"source":"NPPES","snapshot_date":"2017-02-16","doc_url":"https://findmynpi.com/api"}}