While you do need to install NPM, you don't necessarily have to use it. In late 2016, Facebook released an alternative package manager named Yarn, which uses the NPM registry, so all of your favorite packages are available. 

There are likely other package management alternatives to NPM as well. These alternative package managers are important because they drive improvements in NPM, but ultimately, they will likely fade and NPM will continue to be the preferred package manager for Node, and for JavaScript in general. If you do decide to use an alternative package manager such as Yarn, you will need to install it using NPM.