Individual
JUSTIN BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 HOSPITAL PLZ, STAMFORD, CT 06902-3602
(203) 279-7022
(203) 276-5560
Mailing address
1 HOSPITAL PLZ, STAMFORD, CT 06902-3602
(203) 276-7022
(203) 276-5560
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
6945
CT
Other
Enumeration date
12/31/2024
Last updated
03/07/2025
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