MEDICARE: ON THE RUN SURGICAL SUPPLIES INC.,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	CFO075	NY
2	335E00000X	Prosthetic/Orthotic Supplier	CFO075	NY

General Provider Information

NPI Number	:	1154429926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON THE RUN SURGICAL SUPPLIES INC.,

Provider Business Mailing Address
First Line	:	8015 17TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-2105
Country	:	US
Telephone Number	:	347-743-1229
Fax Number	:

Provider Business Practice Location Address
First Line	:	8015 17TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-2105
Country	:	US
Telephone Number	:	347-743-1229
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANTHONY LICAUSI
Credential	:	CFO
Telephone Number	:	347-743-1229

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/11/2025

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